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High-Dose Rate Interstitial Spine Brachytherapy Using an Intraoperative Mobile Computed Tomography-Guided Surgical
Rogelio Medina1, Luke Macyszyn1, Andrew S Lim2
1Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA.
Operative Neurosurgery (Hagerstown, Md.)
|October 20, 2021
Summary
High-dose rate (HDR) brachytherapy using intraoperative CT-guided navigation offers a new option for treating progressing metastatic spine tumors. This technique shows promise for controlling tumors and relieving pain while managing radiation risks.
Area of Science:
- Oncology
- Radiation Oncology
- Medical Physics
Background:
- Metastatic spine tumors can progress after initial radiation, necessitating re-treatment.
- Re-irradiation carries a significant risk of spinal cord damage due to radiation tolerance limits.
- High-dose rate (HDR) brachytherapy presents a potential alternative for managing these challenging cases.
Purpose of the Study:
- To develop and evaluate a novel technique for HDR brachytherapy in metastatic spine tumors.
- To utilize intraoperative computed tomography (iCT)-guided navigation for precise catheter placement.
- To ensure conformal dose delivery and spinal cord sparing during re-irradiation.
Main Methods:
- A cohort of patients with progressive metastatic spine tumors underwent HDR brachytherapy.
- Catheter placement was guided by iCT navigation.
- CT-based treatment planning, fused with MRI, was used for dose optimization and critical structure sparing.
- Treatment was delivered as a single radiation fraction.
Main Results:
- Five patients with thoracolumbar tumors were treated, four with prior radiotherapy.
- Treatment planning ensured adequate target coverage (CTV D90 > 113%) and spinal cord dose limitation (Dmax < 10.3 Gy).
- Three patients experienced pain relief, and four achieved local tumor control at median follow-ups of 22 and 92 days, respectively.
Conclusions:
- HDR brachytherapy guided by iCT navigation is a viable and promising approach for re-treating metastatic spine tumors.
- This technique can effectively achieve local tumor control and alleviate pain symptoms.
- It offers a way to manage radiation dose to the spinal cord in previously irradiated patients.
